Is your baby breech? (Breech Baby) - Let's find out exactly what this means

As you approach the end of your pregnancy, your baby is now quite big. So he or she doesn't have as much room to move around as before. At this point, most babies are in a head-down position, preparing to be born. During labor, they enter the birth canal head first. But sometimes, the baby's head can be up and the bottom and legs down. We call this a "breech baby ." There are some risks to delivering a baby this way, so you need to be extra careful.

What does it mean when a baby is in the breech position?

Simply put, most babies are born with their heads facing down. This position is medically known as ``Vertex Presentation''. This is the safest and easiest position for a normal (vaginal) birth.

But in a breech position, the baby's bottom or legs are facing the birth canal. Then, the baby's bottom comes out first, then the body, and finally the head. This is a bit more challenging for your obstetrician and gynecologist. And the risks for both you and the baby are a bit higher than with a normal delivery.

In addition to these two positions, sometimes babies can lie horizontally inside the uterus. This is called a ``Transverse Lie''. In such cases, a cesarean section is almost always necessary.

Why are some babies like this? What are the reasons?

It's actually quite common for babies to be in a breech position in the early weeks of pregnancy. However, by 36-37 weeks, only 96% of babies will naturally turn head down. If they don't, only a small percentage, around 3%-4%, will remain in a breech position until the end of pregnancy.

It's often difficult to pinpoint a specific reason why a baby hasn't turned. It could be a coincidence. But there are several factors that increase the likelihood of a breech birth.

How do you feel when the baby is in the breech position?

Your other pregnancy symptoms (e.g., vomiting, nausea) will not change if your baby is in a breech position. However, you may feel your baby's legs kicking in your lower abdomen . You may also feel a hard, round lump in your upper abdomen, just below your rib cage . That's your baby's head.

Your doctor will get a good idea of ​​the baby's position by feeling your belly, but it's best to confirm this with an ultrasound scan .

Can the baby be turned? (External Cephalic Version - ECV)

Yes, there is a way to do it. Around 36 weeks into your pregnancy, your doctor may suggest a procedure called `` External Cephalic Version (ECV)''. Simply put, this involves the doctor placing his hands on your belly and very carefully rotating the baby, trying to turn it head down.

You may feel a little uncomfortable when doing this, but it is a very safe procedure for the baby. Sometimes you can also take medicine to relax your uterus. This will make it easier to turn the baby. This is a procedure that has a success rate of about 50%. This means that one in two people who do it will be able to turn the baby. If this is successful, you will have a chance to deliver the baby normally.

Although ECV is a safe procedure, there are rare cases (about 1 in 200) of complications. For example, if there is a small amount of bleeding from the placenta or the baby's heartbeat is irregular, an emergency cesarean section may be required. Therefore, ECV is only performed in a hospital that has all the necessary facilities for emergency surgery.

How do you deliver a baby if it is breech?

At this point, you have two options. One is to have a planned cesarean section . The other is to try for a vaginal breech delivery . You should discuss this with your doctor well in advance and come to a decision.

If you are having a normal vaginal delivery (Vaginal Breech Delivery)

This is very similar to a normal delivery. There is no significant difference in the methods of using painkillers and medications. However, this attempt is only made in a hospital that has the facilities to perform an emergency cesarean section at any time . Because, even if a vaginal delivery is planned, about 40% of breech babies have to have an emergency surgery at the last minute. Also, a pediatrician is definitely there when the baby is born.

However, in the following cases, your doctor may advise against attempting a vaginal delivery:

• If one or both of the baby's legs are lower than the buttocks (footling breech).
• If the baby is larger or smaller than normal.
• If the baby's head is tilted back (hyperextension).
• If the placenta is located low, it is called ``Placenta Previa``.
• If you have other complications during pregnancy, for example, conditions such as ``Pre-eclampsia``.

If the baby is delivered by cesarean section (Planned Cesarean Section)

Most often, your doctor will advise you to have a planned cesarean section at 39 weeks. By then, the baby's lungs are fully developed. Planned surgeries are safer for the baby than surgeries performed after labor begins.

Imagine you have a surgery scheduled for the day, but before that you start having diarrhea. If that happens , you need to go to the hospital immediately.The doctor will examine you. Sometimes, if you are very far along in your labor and the baby is very close to being born, they may decide that a normal delivery is safer than a caesarean section at that time.

Although a planned surgery is safe for the baby, there are some risks for you, the mother . These include:

• Bleeding more than normal
• Blood clots in the legs
• Surgical wound infection
• Damage to the urinary system during surgery
• Increased chance of having to undergo cesarean section in future pregnancies

What are the special risks of a breech birth?

The largest part of the baby's body is the head. If the head cannot come out during a normal delivery (the head comes out), surgery may be needed immediately. However, in a breech delivery, the baby's head can get stuck inside after the entire body comes out . This is a very dangerous situation.

At this point, the baby's umbilical cord can become compressed, cutting off the baby's blood and oxygen supply . This can cause brain damage within minutes.

Another thing is, if your water breaks before labor begins, the umbilical cord can come out before the baby. This is also an emergency.

Finally, babies born in a breech position are at slightly higher risk of having a congenital defect in the hip bone (Developmental Dysplasia of the Hip - DDH). This is a condition in which the hip bone is misaligned. Therefore, such babies are screened for this condition by having an ultrasound scan of the hip area 4-6 weeks after birth.